922-Apricots Waiver of Inspection Permit

OMB No. 0581-0189

WASHINGTON APRICOT MARKETING COMMITTEE

P.O. Box 2386

Yakima, WA 98907

Telephone and Fax: (509) 457-7697

Waiver No. __________________

WAIVER OF INSPECTION PERMIT

SHIPPER

ADDRESS

TRUCK NAME LIC. NO.

FIRM SHIPPED TO

ADDRESS

Number, Type, and Size of Containers	Commodity and Variety	Grade

The undersigned, a duly authorized representative of the above-named shipper, certifies that the apricots covered by this Waiver of Inspection Permit are in compliance with all of the regulations established by the Washington Apricot Marketing Committee.

(Waiver of Inspection No.) (Authorized Representative)

Date of Shipment Time A.M./P.M. (circle one)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0189. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Rev. 9/13. Destroy previous editions.